Wrinkle Correction with Skin Fillers
Since the beginning of time people have been concerned about their appearance, particularly with regard to facial wrinkles causing premature aging of the face. These concerns typically revolve around the anatomic changes associated with reduced skin hydration, texture change, solar damage, tissue laxity and longstanding muscular contraction. Some of these changes are predetermined by your genetic background while others may be related to lifestyle choices, trauma or simply the passage of time. In any case, the Holy Grail of a youthful appearance remains smooth, soft and supple skin. In addition to traditional skin care, Botulinum toxin (Botox), Juviderm, and Restylane are powerful weapons in the battle against facial wrinkles.
When facial muscles contract, the overlying skin may respond with a wrinkle that is perpendicular to the direction of muscle contraction. This action is responsible for the characteristic features of "crows feet", forehead furrows, prominent nasolabial folds, marionette lines, and perioral fissures. Botox is a neuromuscular toxin that causes temporary weakness of muscle. While Botox may be a "weapon of mass destruction" for military purposes, it is a "weapon of dynamic wrinkle reduction" in a much safer dilute form. Botox has been safely used and FDA approved for treating muscle overactivity for decades. Botox is useful to create a temporary weakness in muscle that stops "dynamic" wrinkles and is best used in the upper face. Skin fillers differ from Botox in that they add volume to skin and reduce "static" wrinkles, or wrinkles at rest, and are best used in the lower face.
Botox and skin fillers are compatible and can be used together like a "hand in a glove".
Restylane and Juviderm are used as skin "fillers" to add volume and soften or eliminate undesirable facial wrinkles. Botox, Restylane and Juviderm have become among the most frequently performed cosmetic procedures worldwide. They have proven to be safe and effective to reduce facial wrinkles with little downtime. Of course there may be side effects with the use of fillers and Botox, but these are usually limited to minor swelling or bruising that resolves within a reasonable period of time. For a more detailed list of indications, side effects, and precautions, please see the company websites listed on this site.
The introduction of Botox, Juviderm, and Restylane created a "feeding frenzy" among providers who deal with facial aesthetic issues. While almost anybody with an opposable thumb is capable of injecting these materials, there is NO substitute for a fundamental knowledge of facial anatomy with an aesthetic sense and medical background to appreciate the limits of these techniques. An aesthetic surgeon whose practice is geared toward facial restoration is most likely to help you achieve your goals in an efficient and cost effective manner. The cost of treatment depends upon your specific need, the type and amount of product(s) used. Dr Edelstein will work with you to achieve the specific aesthetic goals you have in mind within your budget. His teamwork approach allows you to feel in control of the process while allowing you the benefit of his years of experience using these products. In comparison to incisional surgery, the immediate impact and short downtime with Botox and fillers makes these office based procedures even more economical over the long term.
The Physicians Coalition for Injectable Safety was created to help patients understand the value of a qualified physician using appropriate judgement and technique to maximize safety in using Botox and other injectables. While many patients use price as the sole criteria for the person providing their injections, please understand that there is no substitute for a complete knowledge of anatomy, adequate training, and experience to avoid the pitfalls associated with injectables. Here are some points to consider prior to having your injection:
- Recognize that injectables are medical treatments and belong in the hands of a qualified doctor.
- Choose only U.S. FDA-approved injectables for a use that is specifically cosmetic and an application that is similar to your condition.
- Accept that there is no such thing as a “generic” or “substitute brand” for U.S. FDA-approved injectables.
- Do not accept bargain prices or deep discounts, as you may not be getting a U.S. FDA-approved injectable or an appropriate dosage.
- Do not accept treatment at a party, public gathering, spa, salon or other non-medical setting.
- Do not act on impulse when you choose injectables. Follow proper procedure by learning about your doctor and the treatment you will have.
Please visit the site below for more detailed information regarding injectable safety.
Physicians Coalition for Injectable Safety Site
Restylane/Perlane
Restylane was the first HA filler available to restore skin fullness to correct facial wrinkles. Restylane is a relatively thinner material used for finer skin wrinkles and is placed in the higher layer of the skin known as the mid-dermis. Perlane was introduced as a thicker material that can be used for greater structural support to improve deeper wrinkles and is placed in the deeper dermis.
The HA in Restylane is a crystal clear gel called NASHA™ or Non-Animal Stabilized Hyaluronic Acid. NASHA™ is biodegradable and completely biocompatible with human hyaluronic acid. Restylane has proven to be safe because it is created by a fermentation process and is non-animal based. This virtually eliminates the need for allergy testing or the risk of animal based disease transmission.
Restylane is placed directly into the skin in tiny amounts using an ultrafine sterile needle. In most cases, the treatments are comfortable. However, the skin may be numbed with topical anesthetic cream, ice or local anesthetics, as necessary. After the injection, the Restylane may be contoured with gentle massage. Any injection may cause some swelling or bruising, but the most common side effects are temporary redness and swelling at the injection sites that typically resolve within several days.
Restylane naturally attracts water as it biodegrades which enhances the effect of wrinkle reduction. In many cases, the effect will last between six and nine months. The effect of Perlane may last longer. Additional treatments, if necessary, may be "layered" to create the desired effect.
Juvederm Ultra/Juvederm UltraPlus
Juvederm is a smoother HA dermal filler, approved by the FDA in June 2006, used to soften and fill facial wrinkles in the manner described above. These fillers are used for moderate to severe facial wrinkles around the nose and mouth, particularly the nasolabial folds, sometimes know as your parentheses ( ). Juvederm Ultra and UltraPlus are the only HA fillers that have been approved by the FDA to last up to one year. They are developed using the Hyalcross™ technology, a cross linking process of non-animal HA, that creates a smooth, malleable gel that flows easily into the skin and creates a smooth, natural look and feel. The other HA dermal fillers currently on the market have a granular consistency gel. The granules can be seen with 2.4X magnification, compared to the smooth consistency of Juvederm.
Juvederm Ultra is a thinner product used for finer wrinkles higher in the skin (mid-dermis). Juviderm Ultra Plus is a thicker product that is better used to provide structural support for deeper wrinkles (deep dermis). Juviderm products provide a smooth and natural feel and have been proven safe and effective for persons of color. Studies with Juvederm demonstrated no increased risk of hyperpigmentation or hypertrophic scarring in persons of color.
* All procedure photos are Dr E’s patients pictured before and approximately five weeks after surgery